Provider Demographics
NPI:1508284225
Name:MARION, AMY C (LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:C
Last Name:MARION
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7303 STRATH LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6973
Mailing Address - Country:US
Mailing Address - Phone:843-729-8266
Mailing Address - Fax:
Practice Address - Street 1:15033 BALLANCROFT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4959
Practice Address - Country:US
Practice Address - Phone:704-316-2920
Practice Address - Fax:704-316-2921
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-21082255A2300X
NC21082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer